The goals of this Mentored Patient-Oriented Research Career Development Award (K23) are to 1) identify facilitators and barriers of child food allergy-related anxiety, quality of life, and adherence (defined as allergen avoidance and epinephrine carriage) and 2) develop a pilot intervention to promote food allergy adjustment and adherence that can ultimately be implemented into food allergy clinics. Current estimates indicate 4-8% of children in the United States are diagnosed with food allergy, and more than 40% of US children with food allergy experience severe allergic reactions. The majority of fatal food allergic reactions occur during adolescence and young adulthood, indicating that adolescence is a period of risk for reduced allergen avoidance and epinephrine carriage. Food allergy also leads to significant parent and child anxiety regarding allergen exposure with marked effects on quality of life, and at least 1/3 of children experience food allergy- related bullying. The proposed research project will include 1) longitudinal assessment of psychosocial functioning and adherence among 150 children (ages 10-14) with at least one of the 8 most common food allergies to identify facilitators and barriers to healthy food allergy psychosocial adjustment and adherence, 2) qualitative assessment of 30 parent-child dyads from the longitudinal assessment to further identify key facilitators and barriers, and 3) a 4 session pilot intervention with 20 children with food allergy (ages 10-14) to assess the impact of the intervention on food allergy anxiety, quality of life, and adherence. Specific short-term training goals of this K23 award include 1) training in peer relationships assessment and intervention development, 2) training in advanced statistical methods and innovative clinical intervention approaches, and 3) advanced training in medical food allergy management. The proposed research and training plan will be supported by a multidisciplinary mentor and scientific advisory team with expertise in the medical and behavioral fields of pediatric food allergy, clinical intervention design and implementation, peer relationships, diversity factors related to health behavior, and advanced research methods, as well as the institutional support of Children's National Health System. The candidate's long-term goal is to be an independent investigator who develops and investigates innovative patient-oriented clinical interventions that promote healthy coping and adherence/illness management behaviors among youth with food allergy from diverse backgrounds. The unique, longitudinal data regarding youth with food allergy that will be collected and the clinical intervention that will be developed as part of this K23 will directly position the candidate as a competitive candidate for funding as an independent investigator. This research has the potential for high impact in the community of youth with food allergy and may have direct implications on its medical and psychosocial management.